The clinical effectiveness of counselling in primary care: a systematic review and meta-analysis

P. BOWER a1c1, N. ROWLAND a1andR. HARDY a1a1 National Primary Care Research and Development Centre, University of Manchester; National Health Service Centre for Reviews and Dissemination, University of York; and MRC National Survey of Health and Development, Department of Epidemiology and Public Health, Royal Free & University College Medical School, London

Abstract

Background. Counselling is frequently used in the management of common mental disorders (such as anxiety and depression) in primary care. However, there are concerns over the clinical effectiveness of counselling, both in comparison with usual general practitioner care, and with other treatments such as alternative psychological therapies and antidepressant treatment. This study used systematic review methodology to assess the current evidence-base.

Method. A systematic literature review located seven trials of relevance, comparing counselling with usual general practitioner care, cognitive-behaviour therapy and antidepressant medication. Data on internal and external validity were examined using a standardized quality rating scheme. Data concerning the impact of counselling on symptoms of anxiety and depression were pooled using meta-analytical procedures.

Results. The main analyses showed significantly greater clinical effectiveness of counselling compared with usual general practitioner care in the short-term (standardized mean difference −0·28, 95% CI −0·43 to −0·13, N=741, six trials) but not the long-term (standardized mean difference −0·07, 95% CI −0·26 to 0·12, N=447, four trials). Sensitivity analyses were undertaken to test the robustness of the results.

Conclusion. Counselling is associated with modest improvement in short-term outcome compared with usual general practitioner care, and thus may be a useful addition to mental health services in primary care.

Correspondence:c1 Address for correspondence to: Dr Peter Bower, National Primary Care Research and Development Centre, Williamson Building, University of Manchester, Manchester M13 9PL.